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John, Employment Lawyer
Category: Employment Law
Satisfied Customers: 5630
Experience:  Exclusively practice labor and employment law.
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My wife works in Mass. She had surgery about 6 months ago

Customer Question

My wife works in Mass. She had surgery about 6 months ago which was
approved by her insurance company. She got a call from the hospital billing office today saying that her insurer now claims her insurance was cancelled two days before the surgery. It was apparently done retroactively.
Any recourse in MA for this?
Submitted: 1 year ago.
Category: Employment Law
Expert:  John replied 1 year ago.

It sounds like the employer probably neglected to pay the premium, because usually the insurer will only do this retroactive termination of benefits in that instance (i.e., they give the employer some grace time to make payment, but if they don't they go back and cancel it). An employer cannot cancel health insurance without notice and certainly cannot inform the employee that a plan is canceled after the fact. The employer's failure to submit premium payments to the health insurance carrier is a violation of law called the Employee Retirement Income Security Act (ERISA). Under this statute the employer has a fiduciary duty to pay premiums as they become due and ensure coverage does not lapse. Employers cannot cancel benefits without notice or cancel them retroactively by letting the premiums lapse.

You have an ERISA claim against the employer and possibly the plan as well. You need to find a benefits attorney experienced with ERISA in your area to discuss making this right either through a settlement or lawsuit against the employer and/or plan.

Expert:  John replied 1 year ago.

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